Does gender expression matter in tailoring anti-smoking messages for sexual and gender minority young adults?

INTRODUCTION: Smoking rates among sexual and gender minority (SGM) adults are generally higher than those in the general population. Tailoring anti-smoking messages for SGM young adults is a promising strategy to reduce health inequalities, but ignoring the difference between gender groups within the SGM community is problematic. METHODS: We conducted two experiments to examine whether gender expression affected the perceived targetedness (PT) among SGM young adults aged 18 to 30. In the first study, participants were randomly assigned to view 8 out of 80 images using various gender expressions. In the second study, participants were randomly assigned to one of four conditions (transgender/nonbinary expressions vs. feminine expressions vs. masculine expressions vs. multiple gender expressions) and viewed six anti-smoking campaign messages in each condition. RESULTS: Both studies found that compared to messages with other gender expressions, gender-expansive individuals reported higher PT when viewing messages with transgender/nonbinary expressions. Cisgender sexual minority women reported higher PT when viewing messages with feminine expressions. Cisgender sexual minority men reported higher PT when viewing messages with masculine expressions. There was no significant difference in PT between multiple gender expressions and gender expressions matching individuals' gender identity. CONCLUSIONS: Culturally tailored anti-smoking messages using gender expressions matched to gender identity or messages using multiple gender expressions were more effective in achieving PT than messages using unmatched gender expressions. IMPLICATIONS: Gender is critical to tailoring anti-smoking campaign messages for SGM young adults. We should not view the SGM community as a monolith in smoking interventions and need to tailor messages to different gender groups within the community. Future research should investigate how sexual expressions affect PT and how gender expressions influence persuasion outcomes beyond PT. Additionally, intersectional analyses of multiple social identities may provide deeper insights into the effects of SGM-tailored anti-smoking messages.